Influence of Time to Achieve Target Systolic Blood Pressure on Outcome After Intracerebral Hemorrhage: The Blood Pressure in Acute Stroke Collaboration

Wang X 1 , Yang J 2 , Moullaali TJ 1 , Sandset EC 3 , Woodhouse LJ 4 , Law ZK 4 Show all authors , Arima H 5 , Butcher KS 6 , Delcourt C 1 , Edwards L 7 , Gupta S 8 , Jiang W 9 , Koch S 10 , Potter J 11 , Qureshi AI 12 , Robinson TG 13 , Al-Shahi Salman R 14 , Saver JL 15 , Sprigg N 4 , Wardlaw J 14 , Anderson CS 1 , Sakamoto Y 16 , Bath PM 4 , Chalmers J 1 , Blood Pressure in Acute Stroke (BASC) Investigators

Affiliations 

  • 1 Faculty of Medicine, George Institute for Global Health (X.W., T.J.M., C.D., C.S.A., J.C.), University of New South Wales, Australia
  • 2 Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu (J.Y.)
  • 3 Department of Neurology, Oslo University Hospital, Norway (E.C.S.)
  • 4 Stroke Trials Unit, University of Nottingham, Queen's Medical Centre, United Kingdom (L.J.W., Z.K.L., N.S., P.M.B.)
  • 5 Department of Preventive Medicine and Public Health, Fukuoka University, Japan (H.A.)
  • 6 School of Clinical Medicine (K.S.B.), University of New South Wales, Australia
  • 7 Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, Australia (L.E.)
  • 8 Department of Neurology, Army Hospital Research and Referral, New Delhi, India (S.G.)
  • 9 Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China (W.J.)
  • 10 Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States (S.K.)
  • 11 Stroke Research Group, Norfolk and Norwich University Hospital, United Kingdom (J.P.)
  • 12 Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
  • 13 Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (T.G.R.)
  • 14 Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (T.J.M., R.A.-S.S., J.W.)
  • 15 Department of Neurology and Comprehensive Stroke Center, UCLA, Los Angeles (J.L.S.)
  • 16 Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (Y.S.)
Stroke, 2024 Apr;55(4):849-855.
PMID: 38410986 DOI: 10.1161/STROKEAHA.123.044358

Abstract

OBJECTIVE: To investigate whether an earlier time to achieving and maintaining systolic blood pressure (SBP) at 120 to 140 mm Hg is associated with favorable outcomes in a cohort of patients with acute intracerebral hemorrhage.

METHODS: We pooled individual patient data from randomized controlled trials registered in the Blood Pressure in Acute Stroke Collaboration. Time was defined as time form symptom onset plus the time (hour) to first achieve and subsequently maintain SBP at 120 to 140 mm Hg over 24 hours. The primary outcome was functional status measured by the modified Rankin Scale at 90 to 180 days. A generalized linear mixed models was used, with adjustment for covariables and trial as a random effect.

RESULTS: A total of 5761 patients (mean age, 64.0 [SD, 13.0], 2120 [36.8%] females) were included in analyses. Earlier SBP control was associated with better functional outcomes (modified Rankin Scale score, 3-6; odds ratio, 0.98 [95% CI, 0.97-0.99]) and a significant lower risk of hematoma expansion (0.98, 0.96-1.00). This association was stronger in patients with bigger baseline hematoma volume (>10 mL) compared with those with baseline hematoma volume ≤10 mL (0.006 for interaction). Earlier SBP control was not associated with cardiac or renal adverse events.

CONCLUSIONS: Our study confirms a clear time relation between early versus later SBP control (120-140 mm Hg) and outcomes in the one-third of patients with intracerebral hemorrhage who attained sustained SBP levels within this range. These data provide further support for the value of early recognition, rapid transport, and prompt initiation of treatment of patients with intracerebral hemorrhage.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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